Small Airways, Big Impact: How to Identify Small Airways Disease (SAD) in Clinical Practice (with live Q&A)

The small airways, defined as airways less than 2 mm in diameter, are often referred to as the lung’s “silent zone” because significant pathological changes can occur before abnormalities are detected by conventional spirometry or before symptoms become apparent.¹

Evidence suggests that small airways disease (SAD) is present in a substantial proportion of patients with asthma and COPD, including those with mild disease. SAD is associated with poorer symptom control, increased exacerbation risk, greater bronchial hyperresponsiveness, nocturnal symptoms, reduced quality of life and accelerated disease progression.^2,3

Traditional lung function measures such as FEV₁ are relatively insensitive to small airway dysfunction. Significant small airway obstruction may occur before spirometric abnormalities become detectable, creating a risk that patients are underdiagnosed or undertreated.⁴ Earlier identification of SAD provides an opportunity to intervene before substantial lung damage and disease progression occur.³

Recognition of SAD encourages clinicians to look beyond standard spirometry and consider additional tools such as:

• Impulse Oscillometry (IOS)
• Forced expiratory flow (FEF_25-75%)
• Alveolar FeNO measurements
• Imaging techniques such as CT assessment of air trapping

These approaches can provide a more complete understanding of airway dysfunction and help identify patients whose symptoms are disproportionate to spirometric findings.³

We hope you can join us on 22^nd October 2026 at 13:00-14:00.

References

1. Mead J. The lung’s “quiet zone”. N Engl J Med. 1970;282(23): 1318-1319.

2. Postma DS, et al. (ATLANTIS Study). Exploring the relevance and extent of small airways dysfunction in asthma (ATLANTIS): baseline data from a prospective cohort study. Lancet Respir Med. 2019;7(5):402-416.

3. Usmani OS, et al. Seven Pillars of Small Airways Disease in Asthma and COPD. Chest. 2021; 160:114-134.

4. McNulty W, Usmani OS. Techniques of assessing small airways dysfunction. European Clinical Respiratory Journal. 2014; 1:25898

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• Professor Brian Lipworth

  Consultant Physician

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  Professor Brian Lipworth

  Consultant Physician University of Dundee, Ninewells Hospital & Medical School

  Role and Location
  Asthma & Allergy Research Group, Centre for Cardiovascular and Lung Biology, Division of Medical Sciences, University of Dundee, Ninewells Hospital & Medical School, Dundee and Honorary Consultant Physician, NHS Tayside.

  Memberships
  – Head of the Scottish Centre of Respiratory Research and Clinical Professor of Allergy and Pulmonology at Ninewells Hospital and Medical School, Dundee.
  – Previously visiting Professor at Harvard University Medical School as well as Honorary Clinical Professor at University of St Andrews Medical
  – Currently Honorary Clinical Professor of Medicine at University of Lancashire.

  Research Interests
  Professor Brian Lipworth is a consultant physician with over 30 years’ experience in Clinical Allergy and Pulmonology with a h-index of 104 and 770 publications. He is a research expert in respiratory, rhinology, cardiovascular and metabolic medicine, along with a background in clinical pharmacology. He has been a principal investigator for 15 years, performing 15 GCP trials to date and attracting funding of over £5 million over the past 10 years from the pharmaceutical industry, predominantly as sole applicant grants.

• Monbi Stefanova Chakma

  Clinical Pharmacist and final year PhD candidate

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  Monbi Stefanova Chakma

  Clinical Pharmacist and final year PhD candidate National Heart and Lung Institute (NHLI), Imperial College London

  Role and Location
  Monbi Stefanova Chakma is a Clinical Pharmacist and final year PhD candidate at the National Heart and Lung Institute (NHLI), Imperial College . 

  Education
  She qualified as a pharmacist from King’s College London, during which she collaborated with researchers at Keimyung University, South Korea and industry partners at Intertek, focusing on drug delivery devices and inhalable formulations.

  Research
  Monbi’s PhD integrates patient physiology and psychology in the development of inhaler devices, with a particular focus on dry powder inhalers and the impact of airflow resistance.

  She has showcased her research at leading conferences in the respiratory field, where she has also chaired sessions on inhaler technology (e.g. Drug Delivery to the Lungs 2019, European Respiratory Society 2022-2024, International Society for Aerosols in Medicine 2023-2025)

  Monbi also has a keen interest in small airways disease and its impact on respiratory conditions.

• Alex Chu

  Clinical Research Nurse

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  Alex Chu

  Clinical Research Nurse Imperial College Healthcare NHS Trust

  Role and Location
  Alex Chu is a clinical research nurse at Imperial College Healthcare NHS Trust.

  Education
  He qualified as a registered nurse and has extensive clinical experience across a range of specialties, predominantly within emergency medicine (A&E), before transitioning into oncology and respiratory clinical research. Alex is registered on the Association for Respiratory Technology and Physiology (ARTP) spirometry national register for adult quality-assured diagnostic spirometry.

  Research Interests
  His research interests include inhaler technique in patients with asthma and chronic obstructive pulmonary disease (COPD), respiratory assessment using spirometry and airwave oscillometry, and the development of novel targeted therapies.